AB0220 THE ASSOCIATION BETWEEN LAUGHTER AND FRAILTY IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM THE FAIRY STUDY
Authors: M. Suzuki, T. Kojima, Y. Ohashi, R. Sato, D. Kihira, M. Maeda, K. Kishimoto, K. Terabe, S. Asai, S. Imagama
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In the treatment of rheumatoid arthritis (RA), advances in drug therapy have led to better control of disease activity. However, RA is a systemic chronic inflammatory disease that causes frailty, a fragile state of mind and body. It is important for RA patients, who are prone to physical anxiety due to poor disease control and frailty, to be able to smile and live their lives. While there is anxiety about the disease, daily laughter may be helpful in resolving anxiety and preventing frailty. Although there have been reports on laughter and health, there are no reports on RA and laughter, so we decided to conduct a new study on laughter. <h3>Objectives</h3> The purpose of this study was to investigate the association between disease activity, laughter, and frailty in RA patients. <h3>Methods</h3> Data were obtained from participants in the Fairy study (The prospective cohort study of frailty in patients with rheumatoid arthritis to extend healthy life expectancy), a prospective cohort study of frailty in RA patients at Nagoya University Hospital. A frailty questionnaire was administered to 243 RA patients from February 2021 to January 2022. Patients' subjective assessments of Kihon checklist for frailty (KCL), the 25-question Geriatric Locomotive Function Scale (GLFS-25), Health Assessment Questionnaire Disability Index (HAQ-DI), Beck Depression Inventory-II (BDI-II), and frequency of laughter were investigated using a self-administered questionnaire. The frequency of laughter was divided into four levels: " "Almost every day", "1-5 days per week", "1-3 days per month" and "Never or almost never" [2], and the association with each item was analyzed by analysis of variance. The frequency of laughter was divided into two groups: "Almost every day, 1-5 days per week" and "1-3 days per month, never or almost never", and multivariate logistic analysis was conducted to examine factors affecting laughter. <h3>Results</h3> Mean age (± standard deviation) was 64.5±10.4 years at baseline, 85.6% were female, duration of disease was 13.1±9.9 years, disease activity score (DAS28)-CRP was 1.92±0.84, KCL was 4.7±3.7, GLFS-25 was 15.1±13.6, HAQ-DI was 0.37±0.51, and BDI-II was 10.7±8.0. Regarding drug therapy, 67.9% of the patients used Methotrexate and 23.0% used glucocorticoid. The frequency of laughter was "Almost every day" (43%), "1-5 days per week" (40%), "1-3 days per month" (11%), and "Never or almost never" (6%). The DAS28-CRP was 1.89/1.87/2.15/1.81 (P=0.487), KCL score was 3.5/4.6/7.3/8.1 (P&lt;0.001), GLFS-25 was 13/15/22/21 (P=0.003), HAQ-DI 0.30/0.38/0.55/0.48 (P=0.105), and BDI-II 8.4/10.9/15.1/16.5 (P&lt;0.001) for "Almost every day", "1-5 days per week", "1-3 days per month", and "Never or almost never", respectively. Multivariate analysis showed that KCL score (Odds Ratio [OR]: 0.81, 95% confidence interval [CI]: 0.73-0.90), GLFS-25 (OR: 0.97, 95% CI: 0.94-0.99) and BDI-Ⅱ (OR: 0.91, 95% CI: 0.86-0.95) were independently associated with laughter frequency (Table 1). <h3>Conclusion</h3> We found that frailty was associated with laughter in RA patients with controlled disease activity. Evaluation of laughter as a patient-reported outcome (PRO) may be novel as a positive indicator for patients themselves. Interventions not only for disease activity but also for frailty may lead to a life with laughter. <h3>References</h3> [1] Salaffi F, et al. Prevalence of frailty and its associated factors in patients with rheumatoid arthritis: a cross-sectional analysis. Clin Rheumatol. 2019;38(7):1823-30. [2] Hirosaki M, et al. Effects of a laughter and exercise program on physiological and psychological health among community-dwelling elderly in Japan: randomized controlled trial. Geriatr Gerontol Int. 2013;13(1):152-60. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.